Numerous methods currently exist for performing laparoscopic procedures. One of the more common used methods is known as closed laparoscopy, which utilizes a sharp needle (e.g., Veress needle) to puncture the abdominal wall and insufflate the abdominal cavity with an inert gas, such as carbon dioxide, through the needle. The noted process of insufflating the cavity separates the abdominal wall from the underlying organs creating a gap for the surgeon to work within. A trocar/cannula system is then used to maintain the insufflated cavity and provide a working portal for which instruments can be passed into and out of the abdominal cavity to perform various surgical procedures.
When the laparoscopic procedure is completed, the surgeon must then close the incision site at the inner abdominal wall using suture material to minimize the risk of adverse post-operative events.
Various apparatus and methods have thus been developed and employed to approximate, ligate and fixate the tissue post a laparoscopic procedure. Illustrative are the apparatus and methods disclosed in U.S. Pat. Nos. 919,138, 3,946,740 and 4,621,640.
U.S. Pat. No. 919,138 discloses an approximation method comprising driving a hollow needle through the tissue with the suture material passing through the hollow center lumen. The needle is then withdrawn, leaving the suture material in place, and the suture is tied to complete the approximation.
There are several significant disadvantages and drawbacks associated with such apparatus and methods. A major drawback is that the apparatus and methods are configured and, hence, primarily employed for use in open surgical procedures where there is room for the surgeon to manipulate the instrument.
U.S. Pat. No. 3,946,740 discloses an approximation apparatus that resembles traditional forceps and an approximation method employing same. The approximation apparatus is configured to pinch tissue between opposing jaws and pass a needle from one jaw through the tissue to the other jaw, where grasping means pull the needle and suture material through the tissue.
There are also several significant disadvantages and drawbacks associated with such apparatus and methods. A major drawback is that the apparatus and methods are similarly configured and, hence, primarily employed for use in open surgical procedures where there is room for the surgeon to manipulate the instrument.
Various apparatus and methods have also been developed to approximate, ligate and fixate tissue post a laparoscopic procedure performed via endoscopic surgery. As is well known in the art, a laparoscopic procedure performed via endoscopic surgery often comprises inserting small tubes called trocars into the body cavity. The tubes typically have a diameter between 3-30 mm and a length of about 150 mm (6 inches).
Illustrative apparatus and methods to approximate tissue post a laparoscopic procedure performed via endoscopic surgery are disclosed in U.S. Pat. Nos. 4,621,640 and 4,935,027.
There are several significant disadvantages and drawbacks associated with the apparatus and methods disclosed in the noted patents. A major drawback is that the apparatus are not configured to retrieve the needle from the body cavity. A further drawback is that the arc through which the needles must be driven into tissue is perpendicular to the axis of the device.
More recently, the approximation procedure employed by many surgeons comprises employing a semi-circular needle, attached to and carrying a suture, in a pair of endoscopic needle holders. An illustrative apparatus is disclosed in WO 2012/122129 A1.
The needle holders, which resemble a pair of pliers with an elongated shaft between the handles and the jaws, must be placed down through one of the surgical trocars into the body cavity containing the structure to be sutured.
Because of their size, the needles used in these procedures are generally not able to be held in the jaws of the needle driver while being introduced through the operative trocar. The surgeon must hold the suture in the needle holder jaws, and push the needle holder trailing the needle and suture into the body cavity.
A further drawback of the noted procedure is that the suture and needle combination is dropped in the body cavity, and the needle is then located and picked up and properly positioned in the needle holder jaws. This is a difficult and time-consuming aspect of the current endoscopic technique for suturing.
The needle carrying the suture must also be driven by pronation of the wrist, causing rotation of the elongate shaft, and subsequent arcuate rotation of the semi-circular needle.
A further drawback and limitation of this type of needle driver is that the needle may only be driven or rotated in a plane perpendicular to the axis of rotation; such axis being defined by the elongate shaft and the position of the surgical trocar. The current endoscopic needle drivers will thus not allow the surgeon to rotate the needle in an arc parallel to the trocar's axis. This is a significant limitation when attempting to ligate vessels, ligaments and other structures that run perpendicular to the axis of the operative trocar.
A further limitation of most current approximation apparatus and associated methods is that, if the surgeon desires to place more than one suture throw through the tissue, he/she must reload the needle into the needle driver. This may be done extracorporeally, i.e. outside the body, in a manner similar to the initial loading of the suture device, or it may be done intracorporeally, i.e. inside the body. This process is a time consuming, and oftentimes is a frustrating exercise in hand to eye coordination.
It is thus desirable to provide an improved suture apparatus and method that substantially reduces or eliminates the disadvantages and drawbacks associated with prior known suture apparatus and methods.
It is therefore an object of the present invention to provide novel suture apparatus and associated methods that substantially reduce or overcome the disadvantages and drawbacks associated with prior known suture apparatus and methods in a simple and economical manner.
It is a further object of the present invention to provide suture apparatus and methods that can be used in conjunction with modern day endoscopic surgical techniques.